Incentive spirometry and positive expiratory pressure improve ventilation and recruitment in postoperative recovery: A randomized crossover study

Reychler, Grégory; Rodriguez, Valeska Uribe; Hickmann, C.; Tombal, Bertrand; Laterre, Pierre‐François; Feyaerts, Axel; Roeseler, Jean

doi:10.1080/09593985.2018.1443185

Cited by 12 publications

(11 citation statements)

References 23 publications

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“…However, the authors do not describe in methodology whether all subjects used the same pressure load during PEP, different from our subjects who were conditioned to PEP of 10 cmH 2 O. As in the present study, a period of at least 48 hours was observed to ensure the wash-out effect between the different devices, whereas Reychler et al [ 28 ] only implemented a 5-minute rest period between the maneuvers, which may justify the increased volume of one device over the other.…”

Section: Discussioncontrasting

confidence: 53%

“…The authors hypothesized that the 10 cmH 2 O intensity would be more comfortable and safer for the subjects. A recent study [ 28 ] evaluated healthy older subjects to assess acute effects of IS-v (self-paced) and PEP (10 to 20 cmH 2 O) using electrical impedance tomography. The authors concluded that both devices promote lung ventilation and recruitment in individuals after surgery, with greater values for end-inspiratory and end-inspiratory volumes while using the devices.…”

Section: Discussionmentioning

confidence: 99%

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Acute effects of three pulmonary reexpansion modalities on thoracoabdominal motion of healthy subjects: Randomized crossover study

et al. 2019

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BackgroundChest physiotherapy can be an alternative to increase lung volumes through pulmonary expansion therapies, but there is still inconsistency in the literature in order to determine which device can promote a greater volume increase at the expense of a better ventilatory pattern. Therefore, the aim of this study was to evaluate and compare the chest wall kinematics of healthy subjects submitted to the use of three different devices for pulmonary reexpansion.MethodsChest wall compartmental and operational volumes, breathing pattern and thoracoabdominal asynchrony were evaluated in 12 healthy individuals through optoelectronic plethysmography during quiet breathing, pulmonary reexpansion and recovery. Three different devices (volume-oriented incentive spirometer–IS-v; positive expiratory pressure–PEP; and incentive spirometer volume and pressure oriented–IS-vp) were administered in a random order with at least 48h between the devices.ResultsA greater volume variation in the chest wall and its compartments was observed when the IS-vp was used in comparison with the other devices (p<0.05). Furthermore, the IS-vp mobilizes a greater amount of volume accompanied by greater synchronism between the compartments when compared to IS-v (p <0.05).ConclusionThe IS-vp may be able to increase total and compartmental chest wall volumes, as well as improve synchrony among compartments when compared to IS-v and PEP devices, thus constituting an important tool for treating patients with restrictive ventilatory pattern.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Acute effects of three pulmonary reexpansion modalities on thoracoabdominal motion of healthy subjects: Randomized crossover study

et al. 2019

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“…Changes to global EELI in IS and EzPAP have been described in a randomized crossover study in healthy subjects after an endorological procedure. 23 This study found an increase in global ⌬EELI% during the lung expansion therapy maneuver, with no remnant effect up to 5 min after lung expansion therapy and no difference from the baseline measurement. We reported an increase in global ⌬EELI% from the baseline measurements, and this increase was sustained for up to 2 min of post-lung expansion therapy monitoring.…”

Section: Discussionsupporting

confidence: 43%

A Randomized Controlled Trial Comparing Two Lung Expansion Therapies After Upper Abdominal Surgery

et al. 2019

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BACKGROUND: Lung expansion therapy is often ordered after surgery to improve alveolar ventilation and reduce risks of postoperative pulmonary complications. The impact of lung expansion therapy at altering ventilation in patients who are not intubated has not been described. The primary purpose of this study was to determine if there is a difference in dorsal redistribution of ventilation and incidences of postoperative pulmonary complications when comparing incentive spirometry (IS) with Ez-PAP lung expansion therapy after upper abdominal surgery. Our a priori null hypothesis was that there are no differences. METHODS: This randomized controlled trial enrolled adult human subjects after upper-abdominal surgery from January 2017 to November 2018. The subjects were allocated to receive IS or EzPAP 3 times a day on postoperative days 1-5. An electrical impedance tomography device was connected to the subjects for a single lung expansion therapy session on postoperative days 1, 3, and 5 to measure the change in post-lung expansion therapy dorsal end-expiratory lung impedance (⌬EELI%). Lung expansion therapy sessions with electrical impedance tomography included 2 min of normal breathing, 3 cycles of 10 breaths, and 2 min of normal breathing after cycle 3. Postoperative pulmonary complications were screened until hospital discharge. Mann-Whitney, chi-square, and Fisher exact tests were applied. Data were reported as count (n), percentage, and median (interquartile range) for primary and secondary outcomes. Alpha (2-tailed) was < 0.05. RESULTS: A total of 112 subjects were enrolled to receive IS (n ‫؍‬ 56) or EzPAP (n ‫؍‬ 56). Baseline characteristics were equal. Post-lung expansion therapy dorsal ⌬EELI% increased for both groups, but the dorsal ⌬EELI% for IS versus EzPAP on postoperative day 1 (16% versus 12%, P ‫؍‬ .39), postoperative day 3 (6% versus 6%, P ‫؍‬ .68), and postoperative day 5 (9% versus 6%, P ‫؍‬ .46) was not significantly different. Hospital length of stay (4 d; P ‫؍‬ .30) and incidence of postoperative pulmonary complications (3.6% versus 7.1%, P ‫؍‬ .19) were similar. CONCLUSIONS: There was no significant post-lung expansion therapy dorsal ⌬EELI% or postoperative pulmonary complications among the adults who received IS or EzPAP 3 times a day after upper abdominal surgery. (ClinicalTrials.gov registration NCT02892773.)Dräger provided an electrical impedance tomography device and electrode belts.

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“…These 2 factors may have contributed to safety during EPAP and breath-stacking, though no other study that used EPAP or breath-stacking reported adverse effects. 3,[6][7][8]10,17 Finally, this study provides novel physiological information about respiratory maneuvers through EIT monitoring. This noninvasive and bedside device can clinically support individualized chest physiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…5 Lung expansion maneuvers, such as incentive spirometry, have been routinely applied in clinical situations to prevent respiratory complications and to restore lung function in conditions that induce loss of lung aeration. [6][7][8] However, these maneuvers require patient cooperation and cannot be applied properly in those who are bedridden because of a decreased level of consciousness. In this scenario, nonvolitional techniques such as the application of expiratory positive airway pressure (EPAP) 9 and the breath-stacking maneuver can be applied.…”

Section: Introductionmentioning

confidence: 99%

Acute Effects of Lung Expansion Maneuvers in Comatose Subjects With Prolonged Bed Rest

et al. 2020

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BACKGROUND: Patients with decreased consciousness are prone to prolonged bed rest and respiratory complications. If effective in reducing atelectasis, lung expansion maneuvers could be used to prevent these complications. In comatose, bedridden subjects, we aimed to assess the acute effect on regional lung aeration of 2 lung expansion techniques: expiratory positive airway pressure and the breath-stacking maneuver. Our secondary aim was to evaluate the influence of these lung expansion techniques on regional ventilation distribution, regional ventilation kinetics, respiratory pattern, and cardiovascular system. METHODS: We enrolled 10 subjects status post neurosurgery, unable to follow commands, and with prolonged bed rest. All subjects were submitted to both expansion techniques in a randomized order. Regional lung aeration, ventilation distribution, and regional ventilation kinetics were measured with electrical impedance tomography. RESULTS: Lung aeration increased significantly during the application of both expiratory positive airway pressure and breath-stacking (P < .001) but returned to baseline values seconds afterwards. The posterior lung regions had the largest volume increase (P < .001 for groups). Both maneuvers induced asynchronous inflation and deflation between anterior and posterior lung regions. There were no significant differences in cardiovascular variables. CONCLUSIONS: In comatose subjects with prolonged bed rest, expiratory positive airway pressure and breath-stacking promoted brief increases in lung aeration. (ClinicalTrials.gov registration NCT02613832.

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Incentive spirometry and positive expiratory pressure improve ventilation and recruitment in postoperative recovery: A randomized crossover study

Abstract: IS and PEP improved ventilation and recruitment instantaneously without remnant effect after stopping the exercise.

Cited by 12 publications

References 23 publications

Acute effects of three pulmonary reexpansion modalities on thoracoabdominal motion of healthy subjects: Randomized crossover study

Acute effects of three pulmonary reexpansion modalities on thoracoabdominal motion of healthy subjects: Randomized crossover study

A Randomized Controlled Trial Comparing Two Lung Expansion Therapies After Upper Abdominal Surgery

Acute Effects of Lung Expansion Maneuvers in Comatose Subjects With Prolonged Bed Rest

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